04 Airway Management

Question 1

What is the Oropharyngeal Airways (OPA) device?

Answer 1

A curved piece of plastic inserted over the tongue that creates an air passageway between the mouth and the posterior pharyngeal wall.

Question 2

What is OPA useful for?

Answer 2

Useful for anesthetized/unconscious patients whose tongue/epiglottis fall back against the posterior pharynx and obstrcuts air flow

Question 3

When is OPA Indicated?

Answer 3

For pt who do not have a cough/gag/swallow reflex

Question 4

When is OPA contrainidcated?

Answer 4

In a person who is conscious, intact cough, gag or swallow reflex

Question 5

How do you measure for OPA devices?

Answer 5

™To measure the approximate size of the OPA: hold the airway next to the patient’s upper jaw with the front even with the patient’s teeth/ corner of the patient’s mouth to the angle of the jaw.

Question 6

OPA assessment intially?

Answer 6

Initially after – pass hand over the OPA to feel for breath

Question 7

What are ongoing assessments for OPA? (4)

Answer 7

1. ™Suction orally prn
2. ongoing assessment of airway in mouth and breath sounds every 2-4 hours and PRN
3. ™Perform mouth care every two hours
4. ™Remove OPA, assess oral mucosa and tongue, and replace at least once every four to eight hours if kept in place – rarely done

Question 8

What are NPAs used for?

Answer 8

Inserted into nostril to create an air passage between the nose and the nasopharynx.

Question 9

What do you do before inserting NPAs?

Answer 9

Preinsertion – lubricate tube with water based lubricant, advance at an angle perpendicular to the face

Question 10

What are NPAs indicated for?

Answer 10

Indicated for patients with intact cough (weak) and gag reflex who require frequent suctioning but unable to forcefully cough or adequately clear secretions

Question 11

NPAs are contraindicarted in what Pts? 6

Answer 11

Contraindicated in patients:

• Who are anticoagulated
• Have low platelet count
• Bibasilar skull fx
• Basel formities
• Facial trauma
• May be contraindicated in children d/t increased risk of epistaxis

Question 12

What are complications associated with NPAs?

Answer 12

Complications:

• Trauma to nares
• Airway obstruction
• Larygospasm
• Gagging and vomiting

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Question 13

How do you measure for NPAs?

Answer 13

™NPA length – distance from the nares to the tragus of the ear.

™Measure from the tip of the nose to earlobe

™Circumference smaller than diameter of nostril

™Insert until flange is against nostril opening

Question 14

What are ongoing assessments after an NPA?

Answer 14

• ™Ö placement by feeling for air from nostril where NPA is placed. As you do with oral airway.
• ™Check posterior airway:
• ™Auscultate lung sounds
• ™Remove the airway at lease every 8 hours and replace with a new NPA after examining nasal mucosa and nares. Ensure NPA does not fit too tightly restricting circulation to mucosa of nostril.

Question 15

What are some disadvantages of NPAs?

Answer 15

Nares must be closely monitored for skin breakdown if used for a few days.

Question 16

Which is one, OPA vs NPA, is better for consciouc pt with a gag reflex?

Answer 16

NPAs

Question 17

What’s the most effective method to clear the airways?

Answer 17

Coughing and deep breathing.

It will decrease the risk of atelectasis and penumonia if done with early mobility / ambulation.

If there’s an incision, tell pt to hold pillow firmly over incision when coughing

Question 18

What is an incentive spirometer used for?

Answer 18

• Promotes deep breathing and good inspiratory effort
• Frequently used in post op patients to minimize risk of atelectasis and development of PNA
• Can be used with patients on bedrest
• Done hourly while awake

Question 19

What are Peak Flow Measurements used for?

Answer 19

• provide baseline best maximal expiration to evaluate airway diameter.
• Used to determine meds to minimize future asthma attacks
• Will determine the best efforts after bronchodilator therapy
• Provides info as to when to use rescue inhalers
• Helps to determine if there will be failure to respond to treatments
• Helps the patient understand when they should seek emergency interventions for bronchospasm

Question 20

Rate of Neb infusion?

Runs on what?

Answer 20

• Delivers med over 5-10 minutes
• Run on air – preferably
• Flow should be 6-8 liters. If to high patient may receive less med and too low patient may get tired of treatment and stop before completed

Question 21

Why are metered dose inhalers useful?

Answer 21

• Spacer is useful esp with patients who cannot grasp the steps for using an MDI
• It is the preferred method for inhaled medications

Question 22

What is postural drainage?

Answer 22

™Use of gravity to facilitate movement and expectoration of secretions & mucous from various lobes of the lungs and the airways.

™

Question 23

What is Cupping?

Answer 23

Cupping is a gentle rhthmic clapping/cupping parts of the lungs to move/loosen mucus from bronchioles

PD&C – postural drainage and cupping

Question 24

The combination of postural drainage and cupping are often used together to treat what? (3)

Answer 24

1. CF pt
2. Spinal cord injury
3. Pt with pneumonia

Question 25

What does the vibration technique entail and do?

Answer 25

• Technique used in conjunction with percussion and postural drainage…but can be used alone
• Hands on chest using rapid vibration as patient exhales
• Helps to loosed secretions, promotes cough to clear airways
• Devices available to provide vibration are more common then this procedure

Question 26

Contraindications to Postural Drainage and Cupping?

Answer 26

• ™Contraindications
• –Head injuries, ICP
• –COPD
• –History of cardiac disorders – but may be used in some cases especially in pediatrics.

Question 27

What are indications for bag valve mask devices/resuscitation breathing bags?

Answer 27

• Hypoxia, decreased O2 sats that don’t recover with increasing oxygenation
• Hypoventilation (RR,8) and don’t increase with stimulation
• Resp failure or worsening resp status that does not support adequate oxygenation or ventilation
• Resp arrest

Question 28

Bag valve mask ventilation technique?

Answer 28

• ™May deliver breaths without oxygen, then use oxygen when available
• ™Deliver all breaths over 1 second
• ™Deliver breaths in a person with spontaneous circulation: one every 6 – 8 seconds or 8 – 10 breaths per minute – sync with their effort to breath or in between patient’s own breaths
• ™Generally deliver breaths to a person in full respiratory arrest: one every 6 seconds or 10 breaths per minute
• ™If CPR, 30:2 compression-ventilation ratio
• ™